Individual
MS. JESSICA REBECCA LAFOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HIS
Contact information
Practice address
105 N 36TH ST, QUINCY, IL 62301-3704
(217) 221-8550
(217) 292-6564
Mailing address
105 N 36TH ST, QUINCY, IL 62301-3704
(217) 221-8550
(217) 292-6564
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
3492
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3492
IL HIS LICENSE
IL
Enumeration date
06/16/2022
Last updated
07/06/2022
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